Liver Transplant Clinic Patient Education and Home Care

General Surgery & Gastroenterology Surgery specialist shared important information:

Living at Home after Liver Transplant

After liver transplantation, you will start a new lifestyle at home with your loved ones and family. In order to lead a healthy new life, it is of utmost importance that you attend outpatient clinic check-ups on time, take your medications regularly, and pay attention to the rules you need to follow in your social life.

Liver Transplant Outpatient Clinic Controls

Your outpatient clinic visits are very important to monitor the function of your transplanted liver, adjust the dosage of your medications and review your general health.

The first six months after surgery are considered the critical period in liver transplantation. After this period, the possibility of rejection (the immune system's response to the elimination of organisms or substances perceived as foreign by the body's immune system) begins to decrease.

Rejection of transplanted tissues (tissue transplantation) or organs (organ transplantation) by the recipient organism is also defined as rejection.

Emergency Situations

If any of the following situations occur, you can contact the organ transplant outpatient clinic urgently. If this situation occurs outside of outpatient clinic hours, you can contact your physician or the organ transplant coordinator.

• Fever of 38 degrees and above Shortness of breath
• Cough, phlegm
• Decrease in the amount of urine, burning sensation, and discoloration of urine
• Persistent pain, swelling, and redness at the surgical site
• Recurrent vomiting, diarrhea
• If you have a problem with your tooth and your dentist has recommended antibiotic treatment
• New skin rashes, itchy lesions 
• If any vaccination is given or recommended

Routine Controls

Regular check-ups after liver transplantation are of utmost importance both to maintain general health and to prevent possible complications. For this reason, especially in the first year, you should follow the check-up dates specified by your physician.

After the transplantation, you are required to come to outpatient clinic controls at the periods specified below.

• 2 days after discharge
• 1 time per week for the first three months after transplantation
• After the 6th month after transplantation, 1 time in 3 weeks according to the patient's condition

Infection Prevention

You must follow the rules below to protect yourself from infections in general and in the first six months in particular.

• If you use air conditioning in your home, you should make sure that the filters are cleaned regularly.
• Raw vegetables and fruits should be consumed after washing them very well.
• In the first six months after transplantation, you should definitely wear a mask in crowded environments such as public vehicles and hospitals.
• Oral and dental health is also very important after transplantation. If you are taking aspirin and similar blood thinners, you should stop taking them about a week before dental treatment.
• You should pay attention to keeping your hands clean during the day. You should wash your hands before and after using the toilet, and before and after meals.
• In the first days when immunosuppressive drugs suppress immunity, you should especially pay attention to the surgical wound, keep the wound clean, and inform your physician in case of swelling, temperature increase, and redness.
• Whenever you feel any change in your fever, you should measure it and inform your doctor if it is 38 degrees and above.
• Especially in the first six months, you should not receive visitors at home.
• You should take care of the cleanliness of your house and try to be in the airy and sunny part of it.
• During the day, you should never accept visitors who have an infectious disease, even if it is a cold or flu, and you should stay away from environments where these people are present.
• You should pay attention to your body hygiene and make sure that your materials such as towels, combs, razors, and nail clippers are personalized for you. Male patients should shave their beards at home instead of a barber.

Follow-up at Home after Liver Transplantation

After you are discharged after liver transplantation, some follow-ups should be done regularly at home. The most important of these are fever measurement and blood pressure monitoring. You should pay attention to follow-ups on the days and times recommended by your doctor. If you have diabetes, you should record the sugar measurement values in a notebook and bring your recorded sugar measurements with you to the outpatient clinic control.

Nutrition Considerations

Restrictions in your diet will be reduced after liver transplantation. However, cortisone, which is one of the drugs used, causes water and salt retention in the body and increases appetite. Therefore, weight gain is common after transplantation.

To prevent weight gain after transplantation;

• Food should be low in salt.
• Elaborate and fancy tables that will increase appetite should not be preferred.
• It is important to consume low-calorie vegetables at meals.
• Drink water during meals.

After liver transplantation, protein breakdown in the body increases due to the cortisone drugs used and the transplant surgery. You should therefore choose a protein-rich diet. You also no longer need potassium and fluid restriction. Although there is no special diet in the post-transplant period, your diet should not be the same as in the pre-transplant period.

As far as possible, you should pay attention to the following points about nutrition.

• Choose white meat instead of red meat.
• Try to use oil instead of margarine when preparing your meals.
• Drink freshly squeezed fruit juice instead of acidic drinks (except grapefruit and orange juice)
• YOU ARE STRICTLY FORBIDDEN TO EAT MUSHROOMS,
• Choose whole wheat bread instead of white bread.
• If you are taking medicines with cyclos+porine and tacrolimus as active ingredients, do not take these medicines with citrus fruits such as oranges, lemons, and tangerines.
• Do not use carboys and water that has been left to stand. Prefer small bottles that you can consume quickly.
• Consume pasteurized milk and dairy products. Never eat or drink products sold in the open.
• Make sure that your fluid intake does not fall below 3 liters during the day.
• Try to consume yogurt, milk, and fruit in your snacks instead of food.

What to Do Against High Blood Sugar Due to Liver Transplantation

One of the side effects of the drugs used after transplantation is elevated blood sugar. This may be temporary or permanent. For this reason, patients with high blood sugar should be careful not to gain excess weight and follow a regular diet for the rest of their lives.

It will also be useful to pay attention to the following points.

• Age, weight gain, and a family history of diabetes can raise blood sugar levels.
• Reducing cortisone and eating a regular diet can help control blood sugar.
• In case of high blood sugar, it may be necessary to use oral antidiabetics or insulin.
• Regular check-ups should be done at diabetes outpatient clinics.

Things to Consider When Exercising

Exercising regularly can help you feel better and return to your daily life faster.

The point to be considered here is that the exercises should be of a nature that does not put a burden on the liver. In the beginning, walking will be a good exercise method. After 6 months, you can swim, play tennis, and ride a bicycle.

Things to Consider During the Social Adaptation Process

• You should not go to public places for the first 6 months.
• You can start school or work after 6 months. You should get a flu shot every year.
• You should wait until after the first 6 months to travel. You should not carry more than 5 kg of weight.
• You should not use belts that tighten the waist at the liver level. You should not keep birds or grow flowers at home.
• One year after the transplant, you can work in the garden wearing gloves.
• After 6 months, you can swim in the sea, but you should never go in the pool for the first year.
• You should never smoke, smoking can damage not only your heart and lungs but also your entire vascular structure. It shortens the life of the transplanted liver.
• You should never drink alcohol.
• You should not have laser epilation for the first 6 months.

Sexual Life Rules

• You should not have sexual intercourse for the first 6 weeks.
• Condoms are the best method of protection and you should always use them.
• Both male and female patients can have children after transplantation.
• If you are planning a pregnancy, you should definitely inform your doctor about this and plan accordingly.

Things to Consider When Taking Medication

After transplantation, your body recognizes the liver tissue as foreign, and your immune system attacks the invader. Immunosuppressive drugs weaken your immune system's response and prevent the rejection of the transplanted liver.

However, at the same time, immunosuppressive drugs make you more prone to infections. A balance is therefore needed between the conflicting needs to prevent rejection and to maintain adequate defenses against infection. Fortunately, the amount of immunosuppressive drugs needed to protect a transplanted organ decreases after the first months after surgery. Still, immunosuppressive drugs are needed for many years after transplantation.

You will be explained in detail about the medication, the medication schedule, and how to take the medication, and you will be given the necessary information documents.

You should use the medicines in the direction recommended by your physician and adjust the amount and dose of medication as recommended by your physician. You should not change the dose and amount recommended by your physician. If you are going somewhere, you should definitely take backups of your medicines with you.

You should never take your medicines with alcohol, grapefruit, and orange juice. (Grapefruit and orange juice: should not be drunk because they affect the level of immunosuppressive drugs in the blood).

You should not use any medicine without the knowledge of your doctor. If you vomit after taking medicine:

• If vomiting develops within 1 hour, you should take the same dose of the medicine.
• If vomiting occurs within 1 hour after taking the medicine, you should definitely call your doctor.